Representation of nurses and nursing through popular image and culture

There are several articles covering the representation of nurses and nursing through popular image and culture which tend to feature examples of literature, TV shows and films. Historical content is covered but media and online sharing has developed over the last few years. One nurse researcher started to address images on YouTube, and now Gifs and memes have been added the image of nurses / nursing – often shared by nurses, colleagues of nurses and family and friends. Since the 1900’s, postcards collections have contained images of nurses and nursing, and now collections encompass Pinterest, Facebook and Twitter.

Darbyshire (2014) explains that there is more literature on images of nurses than other professional groups. Most of it is collated by nurses so he argues that nurses have the issue with the way in which they are portrayed.

Images of a modern caring nurse appeared in the 14^th century which was a change from the Romano Greek idea of the baby nurse. Religious orders had caring nuns who taught women in communities how to care. But some were burnt as witches under religious persecution orders. In the 15^th century, Kampers (1988) identifies the observation that “several features were common to the scenes of nursing sisters help to define the nature of their role; they nurse patients who are most often men lying in bed, they work in a distinctive location that does not look like a house, they wear distinctive costumes, their activities are domestic and religious rather than specifically medical and most importantly they are never subordinated to patients and doctors.” (Kampen, 1988 cited by Derbyshire, 2014).

The earliest referenced photographs of nurses were a few taken of Florence Nightingale during her career as a nurse which enhanced the stereotypical view of a nurse. Today nursing roles are many and varied, from community nurses to acute medical nurses, operating theatre nurses and including mental health and children’s specialisms. Nurses in the UK have been recruited internationally since the 1960’s and in 2007, Mary Seacole (Florence Nightingale’s Jamaican contemporary) was introduced to the National Curriculum in a bid to embrace multiculturalism? By comparison there is only one known photograph of Mary Seacole. This appears to show her place of work. She is cast in a very similar pose to Florence Nightingale with her head not looking towards the viewers.

Lizzie Cadwell Smith’s photograph (figure 6)showed the viewers a personal side of Nightingale. However, male photographers were still capturing the formal portrait. 

Figure 7 Red Cross Nurse (1924) 

August Sander’s photograph from People of the 20^th Century was entitled “Occupation – group: the woman This studio portrait gives no clues as to the working conditions or location of the nurse.

Figure 8 Nurse (1951) 

Irving Penn included the nurse portrait in his “Small Trades” body of work in the early 1950’s; a series of 250 portraits of people initially recruited from New York, London and Paris. Workers were photographed against a plain background wearing their uniform and with their tools. The nurse appears with her hands as tools of trade. Penn thought that “taking people away from their natural circumstances and putting them into the studio in front of a camera did not simply isolate them – it transformed them. (Penn, as cited by Elysée Lausanne, 2010). A press release for the J Paul Getty Museum (2009) describes Penn’s work as “austere and theatrical”. Lacoste (2009) explains that Penn conveys workers’ pride.

Figure 9 Eight Student Nurses (1966) 

In I964, Gerhard Richter’s Eight Student Nurses painted from individual photographs of student nurses murdered by a serial killer, the nurses remain anonymous (although their names were published in a newspaper at the time) and the nurses gain collective identity. The typology paintings were the same size and Gerhard Richter blurred the images slightly as if to remove some identity but kept distinguishing features such as hairstyles.  

Figure 10 Surf safari Nurse (2002-3) 

Richard Prince’s nurse paintings (2002-08) use popular novels as the source material. Prince scans and prints onto canvas before painting, sometimes changing the book title. He retains the characteristics of the nurse and constructs a stereotypical fantasy. Viewers are asked to reconsider the American visual culture depicting the nurse.

Modern student nurses are taught to critically review historical and contemporary representations of nursing so that they have a public and professional voice when dealing with major health care issues raised by the media and can challenge public perception.

“Even stereotypes are regarded as dubious, may after a measure of exposure become internalised and naturalised, they are thereby metamorphosed into categories of the normal, the real and the healthy and desirable.” (Delacour, 1991, as cited by Darbyshire, 2014) Academics have used different categorisations and the majority have been depicted in popular culture.

 “Muff (1982) suggests 6 major nursing stereotypes: Angel of mercy, handmaiden of the physician, Omen in white, Sex symbol / idiot, battle-axe, torturer.” (Darbyshire, 2014)

Dunn (1985) credits the average tabloid newspaper [with] only 3 types of nurse; angel, battle-axe and nymphomaniac. (Darbyshire, 2014)

Kelly’s (2011) YouTube study identifies 3 stereotypes, 2 are similar such as sexual plaything and witless incompetent although nurses are engaging with audiences through the skilled knower and doer stereotype although there may be more as it was a fairly small study and subjective interpretation by nurse researchers could equate differently if different groups of researchers undertook the same study.

Hoeve (2014) suggests that Bridges (1990) found 34 stereotypes. Kalisch and Kalisch (1981) categorised them into time frames. Angel of Mercy 1854-1919, Girl Friday 1920-1929, Heroine 1930-1945, Sex Object 1960-1982, Careerist 1983-present.

Angels with pretty faces and empty heads

Figure 11 The White Angel (1936) 

Figure 12 Lady with a lamp (1951)

Australian nurses in the 1800’s were “redefining image of nurses as motivated primarily by self-sacrifice.” (Bashford, 1997, as cited by Darbyshire, 2014) Nurses appeared in movies such as The White Angel (1936) and Lady with the Lamp (1951) which was Nightingale repackaged. Most cinema goers were women, so this was an ideal time to advertise to boost recruitment. Culturally women had become used to going out to work.

 In Catholicism, the symbol of the angel is used to obey, uncritical of what is written. Created by God – therefore women don’t need to be educated because they are divine and virtuous which opens arguments about pay, education and skills.

Doctor’s handmaidens

Figure 13 Chicago Hope (1994-2000)

This stereotype was based on military and Christian origins (Nelson 2001 as cited by Darbyshire, 2014)

A 19^th century idea was that nurses helped the physician and not the patient. Skills were borrowed from physicians and were not questioned. Popular TV series such as Chicago Hope were developed.

This stereotype still exists among some nurses.

Battle-axe

Figure 14 Carry On Nurse (1959) 

A battle-axe is represented as an asexual, large person who is usually cruel. These stereotypes have Feminist ideas and challenge male power. They could be in a managerial role e.g. matron. Hattie Jaques in Carry On Nurse (1959) and Carry on Matron (1972). There was over a decade between the two films but the stereotype remained the same.

In looking to address this stereotype, nurses removed the formality from their job titles – e.g. “Staff Nurse ….” to first name. Patients were not sure who was the nurse.  In a frightening theatre environment, first names still apply although job roles or descriptions are stated in introductions to patients because all staff wear scrubs.

Naughty nurse and nymphomaniac

“Translocated ideal” (Hunter 1988 as cited by Darbyshire, 2014)

In nursing, traditional social power relations are reversed when a patient comes into hospital. The balance of power is reversed, and men may sexualise the encounters with nurses and fantasize. Nurses work without sexualising the encounter. The nurse becomes a metaphor for sex and subservience to men and can be seen in pornographic films.

Skilled knower and doer

YouTube Nursing videos show techniques and celebrations featuring multi-cultural staff and male nurses. In Kelly’s YouTube presentation of her study, “The Image of You – constructing nursing identities in YouTube” (2011) she explains that identity is “contextually variable description that draws on cultural meanings and the kind of person that one is can be bounded by the acceptable descriptions available at a [particular historical – cultural juncture.” […] “It is socially constructed through public discourses, is a linguistic construction, can be constructed in written and spoken language and other texts such as photographs and film.” (Kelly, 2011)

Kelly (2011) argues that nurses who wanted “likes” on YouTube knew how to reach audiences in which they thought they were promoting the nurse as a skilled doer but used objectification and sometimes placed the nurse in the other 2 categories (witless incompetent and sexual plaything) without realising. The main users of YouTube are young males and YouTube sends a suggestion to the viewer based on what they have already watched thereby not overcoming the stereotype if the watcher has previously chosen to watch a sexual plaything video.

Other studies which have taken place include Stanley’s (2008) study of 36,000 film synopses. Early films showed self-sacrificial heroines, sex objects and romantics and later films showed “strong, self-confident individuals.” (as cited by Hoeve, 2014) In a bid to be more open about roles, a postcard collection collected by Nurse Michael Zwerdling held digitally in the National Library of Medicine includes 600 images of nurses from 1893-2007. This includes images such as male nurses in New Jersey (1910) and accurately represented theatre nurses in 1951 (USA). Images copyright – see link https://www.nlm.nih.gov/news/zwerdling_postcard_collection.html

There are two schools of thought around how nurses should respond to the stereotyping of nurses in the media. In comedy, it should probably be left alone. In documentary, nurses should work with the directors in ensuring there is accurate representation of their role. If the stereotypes are changed, what will they become? There is a tendency for nurses to avoid challenging the media as they do not handle negative criticism and inaccurate portrayal well. Kelly (2011) reasons that responsibility should lie with professional representatives to moderate YouTube content through lobbyists and individual responsibility should be mindful of uploading user generated content which can have a negative impact on stereotypical issues. Recommendations from her study included a counter discourse. Student nurses are taught about self-concept and public identity. “Negative public image has a negative impact on nurses’ self-concept and the development of their professional identity.” (Hoeve, 2014)

List of illustrations

Figure 1 Hering, H (1856-7) Florence Nightingale [photograph] Available at:  https://www.npg.org.uk/collections/search/portrait/mw111411/Florence-Nightingale?LinkID=mp03298&wPage=0&role=sit&rNo=10 Last accessed 26/2/18

Figure 2 Kilburn, W E (1856) Florence Nightingale [photograph] Available at: https://www.npg.org.uk/collections/search/portrait/mw123091/Florence-Nightingale?LinkID=mp03298&wPage=0&role=sit&rNo=11 Last accessed 26/2/18

Figure 3 Lenthall, H (1864-77) Florence Nightingale [photograph] Available at: https://www.npg.org.uk/collections/search/portrait/mw17094/Florence-Nightingale?LinkID=mp03298&wPage=0&role=sit&rNo=16 Last accessed 26/2/18

Figure 4 Mary Seacole (1873) [photograph] Available at: https://en.wikipedia.org/wiki/Mary_Seacole last accessed 26/2/18

Figure 5 Payne, S G and son (1891) Florence Nightingale [postcard]Available at: https://www.npg.org.uk/collections/search/portrait/mw150696/Florence-Nightingale?LinkID=mp03298&wPage=1&role=sit&rNo=24 Last accessed 26/2/18

Figure 6 Caswell Smith, L  (1910) Florence Nightingale [photograph] Available at: http://www.dailymail.co.uk/news/article-1054508/Uncovered-The-haunting-photograph-Lady-Lamp-Florence-Nightingale.html last accessed 26/2/18

Figure 7 Sander, A (1924) Red Cross Nurse [photograph] Available at: https://www.nationalgalleries.org/art-and-artists/114368/red-cross-nurse-1924 last accessed 26/2/18

Figure 8 Penn, I.  (1951) Nurse (Small Trades) London. [photograph].  Available at: https://www.pinterest.co.uk/pin/5911043233885078/ last accessed 20/2/18

Figure 9 Richter, G (1966) Eight student nurses [oil on canvas] Available at: https://www.gerhard-richter.com/en/art/paintings/photo-paintings/death-9/eight-student-nurses-5770?&categoryid=9&p=1&sp=32&tab=notes-tabs last accessed 26/2/18

Figure 10 Prince, R (2002-3) Surf Safari Nurse [inkjet and acrylic on canvas] Available at: http://www.richardprince.com/paintings/nurses/ last accessed 26/2/18

Figure 11 The White Angel (1936) [movie poster] https://en.wikipedia.org/wiki/The_White_Angel_(1936_film) last accessed 26/2/18

Figure 12 Lady with the lamp (1951) [movie poster] Available at: https://en.wikipedia.org/wiki/The_Lady_with_a_Lamp last accessed 26/2/18

Figure 13 Chicago Hope (1994-2000) [photograph] Available at: https://en.wikipedia.org/wiki/Chicago_Hope last accessed 26/2/18

Figure 14 Carry On Nurse (1954) [photograph] Available at: http://www.britishpictures.com/photos/photo024.htm last accessed 26/2/18

References

Archino, S (2018) Richard Prince Artist and Overview. The Art Story [online] Available at: http://www.theartstory.org/artist-prince-richard-artworks.htm last accessed 24/2/18

Darbyshire, P and Gordon, S. (2014). Exploring Popular Images and Representations of Nurses and Nursing. [online]  Available at: https://www.researchgate.net/profile/Philip_Darbyshire2/publication/242512464_Exploring_Popular_Images_and_Representations_of_Nurses_and_Nursing/links/0046353cc6d145e48f000000/Exploring-Popular-Images-and-Representations-of-Nurses-and-Nursing.pdf last accessed 11/12/17

Elysée Lausanne (2010) Irving Penn Small Trades [online press release] Available at: http://www.elysee.ch/fileadmin/user_upload/elysee/Medias/Dossiers/Documents/PressKit_Irving_Penn_EN.pdf  last accessed 20/2/18

Hallam, J. (2001) Nursing the images: Media, culture and professional identity. [online] Available at: https://ebookcentral.proquest.com/lib/ucreative-ebooks/detail.action?docID=165601 last accessed 11/12/17

J Paul Getty Museum (2009) Irving Penn Small Trades [online press release] Available at: http://news.getty.edu/irving-penn-small-trades-related-events-and-publications.tekdownload last accessed 20/2/18

Kelly, J, Fealy, G and Watson, R. (2011) The image of you: constructing nursing identities in YouTube. Journal of Advanced Nursing. [online] Available at: https://www.scribd.com/document/266629346/Journal-of-Advanced-Nursing-Volume-68-Issue-8-2012-Doi-10-1111-2Fj-1365-2648-2011-05872-x-Jacinta-Kelly-Gerard-M-Fealy-Roger-Watson-The-Image last accessed 11/12/17

Ten Hoeve, Y, Jansen, G and Roodbul, P (2014) The nursing profession: public image, self concept and professional identity. A discussion paper. Journal of Advanced Nursing70(2) 295-309 [online] Available at: http://www.truthaboutnursing.org/research/lit/orig/hoeve_2014_jan.pdf last accessed 11/12/17

US National Library of Medicine (2014) NLM launches “Pictures of Nursing: The Zwerdling Postacrd Collection” [online] Available at:   https://www.nlm.nih.gov/news/zwerdling_postcard_collection.html last accessed 12/12/17

Bibliography

Gomez, J (2018) Constructural Available at: https://www.juanagomez.com/constructal last accessed 2/3/18

National Galleries of Scotland (2018) National Galleries of Scotland. August Sander Available at: https://www.nationalgalleries.org/art-and-artists/114368/red-cross-nurse-1924#related-media-anchor last accessed 26/2/18

Prince, R (2018) Paintings Nurses Available at: http://www.richardprince.com/paintings/nurses/ last accessed 26/2/18

Richter, G (2018) Art Available at: https://www.gerhard-richter.com/en/art/paintings/photo-paintings/death-9/eight-student-nurses-5770?&categoryid=9&p=1&sp=32&tab=notes-tabs last accessed 26/2/18